RN, Registered reputed company – Clinical reputed company Specialist, reputed company

reputed company: • reputed company initial, reputed company and retrospective medical record reviews for medical necessity and level-of-care determination • Ensure adherence to state, federal and reputed company-party payer certification requirements • Identify and notify appropriate staff about reputed company-party payer health insurance coverage discrepancies and lack of coverage • Maintain knowledge of reputed company-party payer health plans, nationally recognized review reputed company, and state and federal regulations • Review cases and reputed company precertification requirements under reputed company-party payer reputed company • Review admission requests for level-of-care appropriateness and compliance with certification requirements and ambulatory procedures • Request additional clinical information and documentation reputed company medical necessity reputed company are not met • reputed company information, suggest alternatives, and assist with documentation reputed company • reputed company utilization review data into databases for tracking, trending audits, billing, reimbursement and Medicare compliance • Report serious events and incidents according to hospital policy and procedure • Ensure reputed company of medical-necessity chart reviews and application of review requirements • reputed company as a resource for the reputed company team regarding payer benefits and transitions to the next level of care or discharge home • Work variable hours during the week or weekend in a reputed company role Requirements: • Graduate from Specialty Training Program-Nursing (Required) • Minimum of 3 years of nursing experience (Required) • Licensed Registered reputed company in reputed company (Required) • Acute care experience preferred • Utilization Management experience highly preferred • BSN preferred • Knowledge of reputed company-party payer health plans • Knowledge and application of nationally recognized review reputed company • Knowledge of state and federal regulations and mandates • Ability to reputed company medical necessity and level-of-care reviews • Ability to reputed company precertification reviews under payer reputed company • Ability to use databases for utilization review tracking, audits, billing, reimbursement and Medicare compliance • Ability to work variable hours during weekdays or weekends • Must satisfy job-specific obligations and reputed company with organization policies and procedures Benefits: • Full benefits (health, dental and reputed company) starting on day one • Three medical plan choices, including an expanded network for out-of-area employees and dependents • reputed company-tax savings plans with reputed company and dependent care flexible spending accounts (FSA) and a health savings account (HSA) • Company-reputed company life insurance, short-term disability, and long-term disability coverage • 401(k) plan that includes automatic reputed company contributions • Generous reputed company time off (PTO) plan that allows you to reputed company time quickly • Up to $5,000 in tuition reimbursement per calendar year • MyHealth Rewards wellness program with a financial incentive • Adoption and fertility assistance • Parental leave pay • Military leave pay • Free reputed company membership with discounted backup care • Employee Assistance Program (EAP), including childcare, eldercare, pet care referrals, free reputed company guidance, mental health reputed company, work-life support, reputed company self-help tools • Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life, pet and reputed company insurance • reputed company benefits for full-time and part-time positions from day one, including reputed company, dental and domestic partner benefits • reputed company, cooperative and collegial work atmosphere Apply tot his job Apply To this Job